434411754-9-4-2019-07-CC-JTSE-BFPQY4-20190904123432

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411754
Report Date: 09/04/2019
Date Signed: 09/04/2019 12:34:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ARIAS, CELIA		FACILITY NUMBER:	434411754
ADMINISTRATOR:	CELIA ARIAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 239-0503
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 3	DATE:	09/04/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Celia Arias		TIME COMPLETED:	12:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	LPA Janet Tse met with licensee Celia Arias for an annual/random inspection. LPA explained the nature of today's visit to Licensee. Present were three children with Licensee. Present was also Licensee's daughter, Ana Patricia Arias. Adults living in the home are Licensee, her husband, and their two adult children. Days and hours of operation are Monday to Friday, 7:30am to 5:00pm. LPA toured the indoor and outside of the home. LPA observed stairs were barricaded from the bottom. Off limits indoor: laundry room and the entire upstairs which consists of a master bedroom, a master bathroom, three bedrooms, and one bathroom. There were no bodies of water. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies were inaccessible to the children. Backyard is fenced. LPA observed a storage shed in the backyard. LPA observed the backyard exit leads directly to the community car port area. Licensee understands that children will be supervised when playing in the backyard. LPA reminded licensee that she can only have 14 children according to her license. Fire extinguisher was size 2A10BC and filled. Smoke and carbon monoxide detectors were operable. Home was clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children. Telephone was in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if Licensee transports children, car seat laws shall be followed, and children are never to be left in parked vehicles. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 09/03/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Facility Evaluation Report dated 09/04/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ARIAS, CELIA	FACILITY NUMBER: 434411754
	VISIT DATE: 09/04/2019

NARRATIVE

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Facility Evaluation Report dated 09/04/2019 to be continued from previous page:

LPA reviewed four children's files. LPA observed that in each child’s record has a copy of the emergency information card that contains all of the information specified by regulation. LPA observed that Licensee has completed training on preventive health practices, and has current Pediatric CPR/1^st Aid expiring 08/10/2021. Licensee carries liability insurance; and she understands if she decides not to carry liability insurance, an affidavit regarding liability insurance for FCCH will be issued to parents. A copy of the current roster of the children was provided to LPA today. The fire and disaster drill log documented that the last fire and disaster drill was practiced on 08/09/2019. Licensee understands that the fire and disaster drill shall be practiced at least once every six months.

The Mandated Reporter AB1207 Compliant Child Care Training was discussed. LPA observed Licensee has completed the training on 01/03/2019, and a copy of the certification was in file. Licensee understands that the training shall be completed every two years. Website to complete the training:https://mandatedreporterca.com. LPA observed the required immunization records for Licensee per SB792 were in file. LPA discussed the immediate civil penalties for Zero Tolerance of $500; and an ongoing $100 per day per violation continues until the violation(s) is corrected. The Healthy Beverage Act and AB633 requirements for type A violation were also discussed. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was given a list of the current forms for childcare. Website to download forms and to review Licensing regulations: http://www.ccld.ca.gov. Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates. Periodic information releases accessible by signing up at: www.myccl.ca.gov. Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPA reviewed infants safe sleep policies with Licensee and provided her "A Child Care Provider's Guide to Safe Sleep.” More information can be found at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing.

No deficiency was cited. Notice of site visit was issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC809 (FAS) - (06/04)

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